The Relationship between Movement and Function of the Wrist and Hand: A Clinically Focused Kinematic Study

Metcalf, Cheryl (2008) The Relationship between Movement and Function of the Wrist and Hand: A Clinically Focused Kinematic Study.University of Southampton, School of Electronics and Computer Science,
Doctoral Thesis.

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Description/Abstract

The origins of upper limb movement analysis are derived from a well-established set of protocols defined by research analysing human gait. Due to its repetitive nature, standard gait patterns can be established and comparisons made between standard and pathological gait patterns. The upper limb however is infinitely more complicated due to the apparent redundancy in available movement, which allows for the many possible variations of functional movements in the upper limb. This study investigated the relationship between wrist movement and hand function of the upper limb. A computational measurement technique was developed to generate simultaneous joint angles of the wrist, hand, fingers and thumb. The measurement was tested for accuracy and reliability and implemented in four trials; three unimpaired participant trials and one with impaired participants. Participants’ function was assessed using the Southampton Hand Assessment Procedure (SHAP) during the first unimpaired participant trial. Kinematic analysis of participants completing light and heavyweight versions of the SHAP tasks was captured using a Vicon movement analysis system. The results showed variability in the movement strategies of the wrist across the sample; however an individual would adopt a similar movement strategy when lifting both weighted versions of an object. The results also showed that unimpaired participants moved with a constant wrist angle velocity in flexion/extension during lifting phases. The second and third unimpaired participant trials examined whether an individual would adopt repeated movement strategies over two time periods; sequentially on one occasion and over three-weeks. The results show an individual’s movement strategy for lifting light and heavyweight tasks were highly correlated, even over extended periods of time. Finally, the results of four case studies involving chronic stroke participants were undertaken. Hand function was again assessed using the SHAP. Impaired participants with improved functional scores adopted similar repeated movement strategies and also maintained a constant angular velocity of the wrist. Each impaired participant was assessed using the Functional Independence Measure to consider the affect their impairment had on their quality of life. The results of this study were based within the framework of the WHO ICF (2002) and suggest that in order to maximise recovery, equal attention must be paid to restoring functional mechanisms as well as normalising joint range of movement.